A modified method of laparoscopic side-to-side esophagojejunal anastomosis: report of 14 cases

• Published in: Surgical endoscopy Vol. 22; no. 9; pp. 2091 - 2094
• Main Authors: Ziqiang, Wang, ZhiMin, Cai, Jun, Chen, Xiao, Lei, Huaxing, Luo, PeiWu, Yu
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-09-2008; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Aged; Anastomosis, Surgical - methods; Barium; Biological and medical sciences; Digestive system. Abdomen; Dysphagia; Endoscopy; Esophagus; Esophagus - surgery; Female; Gastrectomy - methods; Gastric cancer; Gastroenterology; Gastrointestinal surgery; General aspects; Gynecology; Hepatology; Hospitals; Humans; Investigative techniques, diagnostic techniques (general aspects); Jejunum - surgery; Laparoscopy; Laparoscopy - methods; Lymph Node Excision; Male; Medical sciences; Medicine; Medicine & Public Health; Mesentery; Middle Aged; Patients; Proctology; Small intestine; Stomach Neoplasms - surgery; Stomach, duodenum, intestine, rectum, anus; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Technique; United States > US; China; Esophagojejunal anastomosis; Minimally invasive surgery; Laparoscopic total gastrectomy; Alimentary tract reconstruction; Gastric cancer; Endoscopic surgery; Laparoscopy; Malignant tumor; Method; Gastrectomy; Stomach cancer; Medicine; Treatment; Digestive diseases; Esophagojejunal anastomosis; Laparoscopic total gastrectomy, Gastric cancer, Minimally invasive surgery; Endoscopy; Cancer; Gastric disease
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-008-9744-z

Background
Alimentary tract reconstruction after laparoscopic total gastrectomy is a technical challenge. Although feasible, reconstruction through a small incision has several drawbacks. The authors therefore report a modified method of laparoscopic side-to-side esophagojejunal anastomosis developed at their hospital.
Methods
The side to side esophagojejunal anastomosis was completed with a endo-GIA firing, followed by transection of the jejunum and esophagus with another firing of endo-GIA.
Results
This modified procedure was performed successfully for 14 patients with gastric cancer. The mean operation time for this procedure was 42.5 ± 10.2 min. No postoperative death, fistula, or hemorrhage occurred. All the patients were followed up for a mean period of 14.5 months with no cancer recurrence at the anastomosis or anastomotic stricture. All the patients had a barium swallow test 6–2 months after the operation. The mean maximum diameter of the anastomosis was 3.8 cm (range, 3.0–4.2 cm). Four patients experienced temporary symptoms of dumping syndrome or dysphagia, which disappeared 6 months postoperatively.
Conclusion
The authors consider this modified laparoscopic side-to-side esophagojejunal anastomosis to be safe, less challenging, and more economical, providing an alternative for alimentary tract reconstruction after laparoscopic total gastrectomy.